HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �/
Date: 9)X)I Permit Number: / g 09 O(!�T _
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COUNTY RECEIVED
F L 0 R �f O' A -
Building Permit Application s
EP 2 8.1018
Planning and Development Services
Building and Code Regulation Division Fe �'tting Department
2300 Virginia Avenue,Fort Pierce FL 34982 Cuda Cau�rY
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Shutter
PROPOSED IMPROVEMENT LOCATION.
Address: 9304 NATURES WAY, FORT PIERCE, FL 34945
Legal Description: PALM BREEZES CLUB (PB 49-32) BLK 8 LOT 4 (OR 2957-1997)
Property Tax ID#: 2310-500-0150-000-9 Lot No. `I'
Site Plan Name: BURNS Block No. 8
Project Name: BURNS
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:„}.;
INSTALLATION OF: (7)ACCORDION SHUTTER SYSTEMS
CONSTRUCTION INFORMATION.
Additional work to be erformed under this permit—check all`ha;apply:
OHVAC II Gas Tank Gas Piping Shutters 11 Windows/Doors
❑Electric ❑ Plumbing 1-1 Sprinklers I I Generator El Roof Roof pitch
Total Sq. Ft of Construction: sol. Ft.of First Floor:
Cost of Construction:$ 2,720.39 Utilities: _Sewer 0 Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name SIMM(E:'BURNS Name: MIRIAM VAN TASSEL
Address: 9304 NATURES WAY Company: DVT HURRICANE SHUTTERS INC
City: FORT PIERCE State: FL Address: 3100 N KINGS HWY
Zip Code: 34945 Fax: City: FORT PIERCE State: FLj
Phone No. 772-971-5898 Zip Code: 34951 Fax: 772-794-1580 j
E-Mail: Phone No. 772-794-1581
Fill in fee simple Title Holder on next page(if different E-Mail: dvthurricaneshuttersinc@hotmail.com
from the Owner listed above) State or County License: 24394
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION :
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no represu
sentation that is granting a permit will authorize the permit holder to build thesubject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comme.rfncing work or recording your Notice of Commencement.
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Signatur of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA1---11---C—e--9-
STATE OF FLORIDA ,
COUNTY OF 54-• �`- - - .� COUNTY OF 5T- L,
The forgoing instrument was acknowledged before me The forging instrument w s ackpowledged .afore me
this v/45 day of 5 Pioteni2Py,20/a by this Nday of .P/L1/20 II. :T
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1 CJl ►7'1 �G:rt. '.'/ r t aYl _ 'I c .,
Name of person aking statement LL�_ > Name of personmaking statemen I E±°
Personally Known V OR Produced Identifics. R Personally Known rr// OR Produced I..:rigtf
Type of Identification , =gi a ' Type of Identification , m(2 E
Produced 4 mm}w Produced ¢ 2
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(Signature otary Public State of Florida ,?;